title: Base deficit correlates with mortality in pediatric abusive head trauma.
abstract: OBJECTIVE
  Children suffering from abusive head trauma (AHT) have worse outcomes compared to non-AHT, but the reasons for this are unclear. We hypothesized that delayed medical care associated with AHT causes prolonged pre-hospital hypotension and hypoxia as measured by admission base deficit (BD), and that this would correlate with outcome.
  
  
  METHODS
  We performed a 10-year retrospective chart review of children admitted for AHT at two academic level-I trauma centers. Statistics were performed using Student's t test, chi-square analysis, and multivariate logistic regression, and considered significant at p < 0.05.
  
  
  RESULTS
  Four-hundred twelve children with AHT were identified, and admission BD was drawn for 148/412 (36%) children, including 104 survivors and 44 non-survivors. Non-survivors had significantly higher BD compared to survivors (12.6 ± 1.6 versus 5.3 ± 0.6, p < 0.001). Non-survivors were more likely to be intubated pre-hospital and get cardiopulmonary resuscitation (CPR) (p < 0.001). Mortality increased with rising BD, according to CPR status. There was no difference in patterns of brain injury between survivors and non-survivors (p > 0.05).
  
  
  CONCLUSIONS
  BD correlates with mortality in children suffering severe AHT. Non-survivors are also more likely to be intubated pre-hospital and require CPR, with no difference in pattern of brain injury, suggesting that secondary injury is a major determinant of outcome in severe AHT.
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Camille.Stewart@ucdenver.edu.
authors.forename: Camille L
authors.initials: CL
authors.lastname: Stewart
authors.forename: Courtenay M
authors.initials: CM
authors.lastname: Holscher
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Micheal
authors.initials: M
authors.lastname: Bronsert
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moulton
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D000138:Acidosis / Q000097:blood / Q000209:etiology*; D002649:Child Abuse / Q000401:mortality*; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D014193:Trauma Centers
keywords: Base deficit; Child abuse; Head trauma